Tailored Multidisciplinary Support Shows Promise in Helping Breast Cancer Patients Return to Work

For the hundreds of thousands of people diagnosed with breast cancer each year, surviving the disease is only the first battle. The second often unfolds quietly, in offices, factories, and hospitals, where fatigue, lymphedema, cognitive fog, and psychological distress collide with the demands of a working life. A new prospective feasibility study from Italy suggests that a carefully tailored, multidisciplinary support program may offer a realistic path back to employment for working-age breast cancer patients, with high adherence, near-universal satisfaction, and strikingly high rates of work reintegration over twelve months.

The study, conducted at the Azienda USL–IRCCS of Reggio Emilia and published in Supportive Care in Cancer, evaluated the UNAMANO project, a social-healthcare pathway developed in 2018 to address the work-related difficulties of cancer survivors living in the Province of Reggio Emilia. Rather than testing effectiveness, the researchers set out to answer a more fundamental question: is such a complex, individualized intervention actually deliverable in a real-world healthcare setting? Feasibility was measured through a series of concrete metrics, including the percentage of eligible patients invited to participate, the proportion who accepted, dropout rates, adherence to the intervention, satisfaction with the support received, and ultimately the rate of return to work.

The clinical rationale for the work is sobering. In Italy, 436,000 new cancer diagnoses were recorded in 2022, and breast cancer accounted for 13.2 percent of incident cases, with nearly half occurring in people of working age. Cancer survivors are 1.4 times more likely to be unemployed than healthy individuals, and while 73 percent of long-term survivors employed at diagnosis eventually return to work, that figure falls to 65 percent six years after diagnosis. Among breast cancer survivors specifically, return-to-work rates range from 56 to 88 percent. The obstacles are both physical and organizational: upper limb disability and lymphedema can make physically demanding tasks impossible, cancer-related fatigue and cognitive problems often prolong absences, and strenuous postures or shift work have been linked to a higher risk of never returning to work within two years of diagnosis.

Compounding these biological challenges is a communication gap within healthcare itself. Patients frequently hesitate to raise employment concerns with their oncologists, and clinicians tend to address work issues only when patients bring them up first. Yet survivors often need concrete information about employment rights, practical workplace accommodations, and emotional support as they navigate the transition from patient back to worker. Previous research has shown that multidisciplinary interventions combining vocational counseling, patient education, and physical exercise can enhance return to work compared with standard care, but these approaches must be adapted to local contexts and individual needs to be effective, a principle that shaped the design of the UNAMANO pathway.

The intervention itself is deliberately flexible. Participants can receive one or more of three types of support: information, occupational therapy, and social support, all provided free of charge. Occupational therapy, the most frequently delivered module, encompasses the collection of work needs, goal setting, and the definition of coping strategies agreed upon with the participant. The pathway also integrates with the broader supportive care services of the Reggio Emilia hospital network, including psycho-oncology, physical therapy, and nutritional support, allowing healthcare professionals to discuss cases and coordinate care across disciplines. Work-related difficulties were systematically categorized using the Core Set-VR-Onco, a checklist based on the World Health Organization’s International Classification of Functioning, Disability and Health that was recently adapted and validated for cancer survivors in the region.

Recruitment proved to be the study’s most instructive challenge. Of 85 working-age individuals with breast cancer recruited from a concurrent observational study, 32, or 37.6 percent, met the eligibility criteria and were invited to participate; half of those accepted and signed informed consent. Notably, no eligible patient who was merely referred to the UNAMANO project during a post-surgical educational session, without the deeper engagement of the observational study, ever contacted the service. The researchers interpret this as evidence that discussing work-related difficulties with healthcare professionals is itself a facilitating factor, and that passive referral may not be enough to connect patients with the support they need. Recruitment peaked at four months after surgery, while most work difficulties and study proposals emerged between seven and thirteen months post-surgery, suggesting that patients may be more receptive to vocational support once the acute phase of clinical recovery has passed.

Once enrolled, participants largely stayed the course. The overall dropout rate was 25 percent, with the highest single loss, 12.5 percent, occurring at baseline: one participant withdrew because of high emotional distress, and another declined to commit to another year of appointments after completing the observational study’s follow-up. Adherence to the intervention remained above 90 percent at the one- and three-month assessments, dipped to 75 percent at six months, and returned to nearly 90 percent at twelve months. Assessment appointments, initially conducted in person and averaging roughly 53 minutes at baseline, shifted steadily toward remote delivery at participants’ request, with nine of the eleven final participants opting for telephone follow-up by the study’s end, a pattern the authors note mirrors findings from a Scottish feasibility study where telephone appointments dominated.

The outcomes were encouraging. By the twelve-month assessment, ten of the eleven remaining participants had achieved work reintegration, whether by returning to their previous workplace or joining a different employer, and the same near-universal rate was observed at six months. Every participant assessed at the final timepoint reported being satisfied with the intervention, a result the researchers attribute in part to the continuous twelve-month follow-up, which continued regardless of employment status even after participants had returned to work. Interestingly, four participants were offered the option of organizing part of the intervention directly at their workplace, but none accepted, and some participants completed their intervention modules before the study formally ended because their needs had already been met, prompting the authors to suggest that future programs could define clearer criteria for concluding support.

The study population itself offers a portrait of the modern working cancer patient: all participants were women with a mean age of 50.7 years, most were private-sector employees with permanent contracts, and roughly two-thirds described their jobs as psychologically demanding while half reported physically demanding work. The authors are candid about the limitations. Recruitment drew exclusively from a cohort of patients who had undergone lymph node surgery and attended an educational session, excluding those with different prognoses and raising concerns about equitable access, particularly since only about 60 percent of eligible patients attend such sessions. The target sample size was not reached, and social desirability bias cannot be excluded, since the occupational therapist who delivered the intervention also conducted the follow-up assessments.

Nevertheless, the findings carry significant weight for the design of future cancer rehabilitation programs. The researchers argue that assessing work-related difficulties and delivering supportive interventions may be more appropriate several months after surgery rather than in the immediate postoperative period, when patients are focused on clinical recovery and prognosis. They call for further investigation of the occupational therapist’s role, which emerged as the backbone of the UNAMANO pathway, and for rigorous effectiveness trials of integrated approaches combining vocational interventions, physical exercise, and psychological support, not only for breast cancer but across cancer types. As survival rates continue to climb, the question is shifting from whether patients will live to how well they will live, and for millions of survivors, a meaningful answer must include the dignity and financial security of a working life restored.

Subject of Research: Feasibility of a multidisciplinary intervention to support return to work in working-age breast cancer patients

Article Title: A multidisciplinary intervention to support return to work of individuals with breast cancer: a prospective feasibility study

Article References: Paltrinieri, S., Braglia, L., Bravi, F., Fugazzaro, S., & Costi, S. (2026). A multidisciplinary intervention to support return to work of individuals with breast cancer: a prospective feasibility study. Supportive Care in Cancer, 34(10), Article 979. https://doi.org/10.1007/s00520-026-11198-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11198-5

Keywords: breast cancer, cancer survivors, return to work, occupational therapy, vocational rehabilitation, feasibility study, cancer rehabilitation, UNAMANO project, multidisciplinary intervention, supportive care, work-related difficulties, ICF framework